Antegrade scrotal sclerotherapy versus inguinal microsurgical varicocelectomy in the treatment of varicocele – a prospective, randomized, parallel group study / A. A. Botha  

Public ISBD Title : Antegrade scrotal sclerotherapy versus inguinal microsurgical varicocelectomy in the treatment of varicocele – a prospective, randomized, parallel group study Authors: A. A. Botha ; C. F. Heyns, Author Publisher: Cairo [Egypt] : Pan African Urological Surgeons' Association Publication Date: 2006 Series: African Journal of Urology, ISSN 1110-5704 No. 12(1) Pagination: p.1-9, fig., tab. Layout: Journal Article ISSN (or other code): 1110-5704 Languages : English Keywords: Sclerotherapy  Varicocele  Randomized  Controlled Trials  Adolescent Abstract: Objective To evaluate the efficacy; safety and cost-effectiveness of antegrade scrotal sclerotherapy (ASS) compared to inguinal microsurgical varicocelectomy (IMV) for the treatment of varicocele of the testis. Patients and Methods Male patients above 13 years of age with grade 2 to 3 varicocele; who were either symptomatic or presented with an abnormal semen analysis; were included in the study. The patients were randomized in a ratio of 1:1 between ASS or IMV. ASS was performed using sodium tetradecyl sulphate (Fibro-veinr) as sclerosing agent in a 1and 3mixture. IMV was performed using an inguinal approach and microsurgery loupes during spermatic cord dissection to identify and preserve the testicular artery and lymphatics. Color doppler ultrasound was used to measure testicular volume and pampiniform vein diameter before treatment and at 6 and 12 month follow-up visits. Semen analysis was obtained at the same time intervals. The efficacy parameters included serum follicle stimulating hormone (FSH); luteinizing hormone (LH); semen analysis; pregnancy rate of partners and estimation of costs involved. Results Between April 2000 and December 2003; 25 patients were included in the study. ASS was performed on 12 patients (6 bilateral procedures) and IMV on 13 patients (2 bilateral). Obliteration of the clinically detectable varicocele was achieved in 10/12 patients in the ASS and in 11/13 in the IMV group (89and 87success rate; respectively). ASS was superior to IMV with regard to costs; average theatre time; hospitalization and postoperative recovery. Both procedures had a one year pregnancy rate of 50. The mean sperm count and mean sperm morphology improved significantly from baseline to 12 months in both groups. However; there were no statistically significant differences between the two methods with regard to semen analysis improvement; testicular volume or biochemical data (LH; FSH; testosterone). Serum FSH decreased in those who had successful treatment of their varicocele; but not in those with recurrence; although the difference was not statistically significant (p=0.09); probably due to the small patient numbers. Conclusion ASS is a minimally invasive treatment for varicocele; which is feasible as an out-patient procedure in adolescents and adults. It can save costs; theatre time; hospitalization and time lost from work. ASS and IMV appear to be equally successful in terms of varicocele recurrence; pregnancy rate and semen analysis improvement. Link for e-copy: https://www.ajol.info/index.php/aju/article/view/8133/30675 Antegrade scrotal sclerotherapy versus inguinal microsurgical varicocelectomy in the treatment of varicocele – a prospective, randomized, parallel group study [] / A. A. Botha ; C. F. Heyns, Author . - Cairo (El Horria - Heliopolis, Egypt) : Pan African Urological Surgeons' Association, 2006 . - p.1-9, fig., tab. : Journal Article. - (African Journal of Urology, ISSN 1110-5704; 12(1)) . ISSN : 1110-5704 Languages : English Keywords: Sclerotherapy  Varicocele  Randomized  Controlled Trials  Adolescent Abstract: Objective To evaluate the efficacy; safety and cost-effectiveness of antegrade scrotal sclerotherapy (ASS) compared to inguinal microsurgical varicocelectomy (IMV) for the treatment of varicocele of the testis. Patients and Methods Male patients above 13 years of age with grade 2 to 3 varicocele; who were either symptomatic or presented with an abnormal semen analysis; were included in the study. The patients were randomized in a ratio of 1:1 between ASS or IMV. ASS was performed using sodium tetradecyl sulphate (Fibro-veinr) as sclerosing agent in a 1and 3mixture. IMV was performed using an inguinal approach and microsurgery loupes during spermatic cord dissection to identify and preserve the testicular artery and lymphatics. Color doppler ultrasound was used to measure testicular volume and pampiniform vein diameter before treatment and at 6 and 12 month follow-up visits. Semen analysis was obtained at the same time intervals. The efficacy parameters included serum follicle stimulating hormone (FSH); luteinizing hormone (LH); semen analysis; pregnancy rate of partners and estimation of costs involved. Results Between April 2000 and December 2003; 25 patients were included in the study. ASS was performed on 12 patients (6 bilateral procedures) and IMV on 13 patients (2 bilateral). Obliteration of the clinically detectable varicocele was achieved in 10/12 patients in the ASS and in 11/13 in the IMV group (89and 87success rate; respectively). ASS was superior to IMV with regard to costs; average theatre time; hospitalization and postoperative recovery. Both procedures had a one year pregnancy rate of 50. The mean sperm count and mean sperm morphology improved significantly from baseline to 12 months in both groups. However; there were no statistically significant differences between the two methods with regard to semen analysis improvement; testicular volume or biochemical data (LH; FSH; testosterone). Serum FSH decreased in those who had successful treatment of their varicocele; but not in those with recurrence; although the difference was not statistically significant (p=0.09); probably due to the small patient numbers. Conclusion ASS is a minimally invasive treatment for varicocele; which is feasible as an out-patient procedure in adolescents and adults. It can save costs; theatre time; hospitalization and time lost from work. ASS and IMV appear to be equally successful in terms of varicocele recurrence; pregnancy rate and semen analysis improvement. Link for e-copy: https://www.ajol.info/index.php/aju/article/view/8133/30675

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Male circumcision and HIV/AIDS Risk - Analysis of the scientific evidence / J. N. Krieger

Public ISBD Title : Male circumcision and HIV/AIDS Risk - Analysis of the scientific evidence Authors: J. N. Krieger ; C. F. Heyns, Author Publisher: Cairo [Egypt] : Pan African Urological Surgeons' Association Publication Date: 2009 Series: African Journal of Urology, ISSN 1110-5704 No. 15(2) Pagination: p.73-83, tab Layout: Journal Article ISSN (or other code): 1110-5704 Languages : English Keywords: Circumcision, Male - statistics & numerical data  HIV infections - transmission  HIV Infections - prevention and control  Acquired Immunodeficiency Syndrome  Egypt Abstract: "Objective: The aim of this review was to evaluate the scientific evidence supporting the hypothesis that male circumcision reduces the risk of HIV infection and consequently the incidence of acquired immunodeficiency syndrome (AIDS). Patients and Methods: We performed a literature search of the major databases (Medline; Embase; Cochrane Library; Biosis and Science Citation Index) for papers published in the period 1999 to 2008; using the terms ""male circumcision""; ""HIV infection"" and ""sexually transmitted infection;"" plus the combination of the search terms ""foreskin"" and ""HIV receptor"" to identify 1;048 articles. We reviewed the abstracts to identify 278 articles meriting detailed review. This detailed review considered how well individual studies were designed and carried out; using a standard checklist to provide a systematic quality rating for individual studies. This process identified a total of 80 papers; which were rated following the level of evidence and grade of recommendation scales modified from the Oxford Center for Evidence-Based Medicine. Results: Detailed analysis of the selected articles on male circumcision and HIV infection risk revealed the following. Systematic reviews; meta-analyses and modeling studies: there were 11 papers; 10 positive (favoring circumcision) and 1 negative; of the 10 positive studies; 4 were level 3 evidence; 5 were level 2 and 1 was level 1 evidence. Randomized controlled trials: there were 3 studies; all positive with level 1 evidence. Non-randomized cohort studies: there were 6 papers; 5 were positive (2 level 3 and 3 level 2 evidence) and 1 was negative (level 3 evidence). Casecontrol studies: there were 12 studies; 11 positive (all level 3) and 1 negative (level 3 evidence). Case series: there were 2 studies; both positive (level 3 evidence). Expert opinion: there were 34 studies; 30 positive (15 level 4; 15 level 3 evidence); 2 negative (both level 4) and 2 neutral (both level 4 evidence). Cost-effectiveness studies: there were 3 studies; all positive; all level 2 evidence. Pertinent biological studies: there were 3 studies; all positive; all level 4 evidence. The three large; exceptionally well-done randomized; controlled trials of adult male circumcision among consenting; healthy men in three African countries enrolled a total of 10;908 uncircumcised; HIV-negative adult men. The cumulative HIV infection risk estimated using intention-to-treat Kaplan-Meier analysis showed an overall rate ratio (RR) of 0.42 (95confidence interval (CI) 0.31-0.57); corresponding to a protective effect of 58(95CI 43-69). Meta-analysis of the ""as-treated"" results of the three trials showed even stronger protection against HIV infection in the circumcision group (summary RR 0.35; 95CI 0.24-0.54). Conclusions: Rigorous analysis of the available scientific evidence clearly supports a positive recommendation that male circumcision should be actively promoted in populations at high risk of HIV infection. There is a need to provide safe male circumcision services for high-risk populations; because this is one of very few proven HIV prevention strategies. Male circumcision provides a much-needed addition to the limited HIV prevention armamentarium. The challenges to implementation must now be faced" Male circumcision and HIV/AIDS Risk - Analysis of the scientific evidence [] / J. N. Krieger ; C. F. Heyns, Author . - Cairo (El Horria - Heliopolis, Egypt) : Pan African Urological Surgeons' Association, 2009 . - p.73-83, tab : Journal Article. - (African Journal of Urology, ISSN 1110-5704; 15(2)) . ISSN : 1110-5704 Languages : English Keywords: Circumcision, Male - statistics & numerical data  HIV infections - transmission  HIV Infections - prevention and control  Acquired Immunodeficiency Syndrome  Egypt Abstract: "Objective: The aim of this review was to evaluate the scientific evidence supporting the hypothesis that male circumcision reduces the risk of HIV infection and consequently the incidence of acquired immunodeficiency syndrome (AIDS). Patients and Methods: We performed a literature search of the major databases (Medline; Embase; Cochrane Library; Biosis and Science Citation Index) for papers published in the period 1999 to 2008; using the terms ""male circumcision""; ""HIV infection"" and ""sexually transmitted infection;"" plus the combination of the search terms ""foreskin"" and ""HIV receptor"" to identify 1;048 articles. We reviewed the abstracts to identify 278 articles meriting detailed review. This detailed review considered how well individual studies were designed and carried out; using a standard checklist to provide a systematic quality rating for individual studies. This process identified a total of 80 papers; which were rated following the level of evidence and grade of recommendation scales modified from the Oxford Center for Evidence-Based Medicine. Results: Detailed analysis of the selected articles on male circumcision and HIV infection risk revealed the following. Systematic reviews; meta-analyses and modeling studies: there were 11 papers; 10 positive (favoring circumcision) and 1 negative; of the 10 positive studies; 4 were level 3 evidence; 5 were level 2 and 1 was level 1 evidence. Randomized controlled trials: there were 3 studies; all positive with level 1 evidence. Non-randomized cohort studies: there were 6 papers; 5 were positive (2 level 3 and 3 level 2 evidence) and 1 was negative (level 3 evidence). Casecontrol studies: there were 12 studies; 11 positive (all level 3) and 1 negative (level 3 evidence). Case series: there were 2 studies; both positive (level 3 evidence). Expert opinion: there were 34 studies; 30 positive (15 level 4; 15 level 3 evidence); 2 negative (both level 4) and 2 neutral (both level 4 evidence). Cost-effectiveness studies: there were 3 studies; all positive; all level 2 evidence. Pertinent biological studies: there were 3 studies; all positive; all level 4 evidence. The three large; exceptionally well-done randomized; controlled trials of adult male circumcision among consenting; healthy men in three African countries enrolled a total of 10;908 uncircumcised; HIV-negative adult men. The cumulative HIV infection risk estimated using intention-to-treat Kaplan-Meier analysis showed an overall rate ratio (RR) of 0.42 (95confidence interval (CI) 0.31-0.57); corresponding to a protective effect of 58(95CI 43-69). Meta-analysis of the ""as-treated"" results of the three trials showed even stronger protection against HIV infection in the circumcision group (summary RR 0.35; 95CI 0.24-0.54). Conclusions: Rigorous analysis of the available scientific evidence clearly supports a positive recommendation that male circumcision should be actively promoted in populations at high risk of HIV infection. There is a need to provide safe male circumcision services for high-risk populations; because this is one of very few proven HIV prevention strategies. Male circumcision provides a much-needed addition to the limited HIV prevention armamentarium. The challenges to implementation must now be faced"

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